11D2060242 CLIA NUMBER - VILLAGE PEDIATRICS, PC

Laboratory Demographics

  • CLIA Code: 11D2060242
  • Facility Name: VILLAGE PEDIATRICS, PC
  • Facility Address: 1862 AUBURN ROAD, SUITE 107
    DACULA, GA
    ZIP 30019
  • Facility Phone: 678 288-4142
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. GINA M. MAXEY
  • NPI Number: 1598101388
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 11D2060242
LAB Type Physician Office
Facility Name VILLAGE PEDIATRICS, PC
Street 1862 AUBURN ROAD, SUITE 107
City DACULA
State GA
ZIP 30019
Phone 678 288-4142
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/10/2025
Certificate Expiration Date 6/9/2027
Facility Type Physician Office
Lab Director DR. GINA M. MAXEY

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This page was last updated on: 9/29/2025